Abstract
A review of the literature on the subject of biliary fistula reveals that the most frequent cause of its persistence is obstruction of the common duct and ampulla of Vater (Cotte; Overholt; Shelley; Doubilet). In the following case, in addition to showing evidence of obstruction, the roentgenogram revealed, also, an abscess pocket at the site of previous rupture of the gallbladder. For the physiological principles of roentgen visualization of the biliary tract after injection of lipiodol, the reader is referred to the excellent article of Doubilet. His assertion deserves repetition at this time: “In short, if lipiodol enters the duodenum without visualization of the hepatics, the sphincter tone is normal or low. If the hepatic ducts are visualized before the lipiodol can be forced into the duodenum, the sphincter is spastic.” Case History Mrs. D. S., white, aged 30, had experienced the usual childhood diseases. She had a tonsillectomy at the age of ten and an appendectomy at the age of twelve. She had fou...
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